the Use of Acid Creams for Acne Treatment: Expert Answers

Acid ointment

Hello Doctor, I have some questions regarding acid-based ointments:
(1) When I apply tretinoin on my neck to treat acne, my skin becomes very itchy.
Should I stop using it to allow the redness and itching to improve, or should I continue using it consistently to treat the acne? I've heard that this is a common purging phase when using tretinoin.
While stopping the medication may alleviate side effects, it could significantly undermine the previous treatment.
(2) Can tretinoin and azelaic acid be applied only to inflamed areas with acne, or can they be used all over the face to prevent new acne and comedone formation? I consulted a pharmacist who said they should only be applied to inflamed areas, but my treating physician said they can be used all over the face without developing resistance.
(3) After treating inflamed acne with tretinoin and azelaic acid, can I continue to use them as part of my daily skincare routine? Some say that once the inflamed acne is gone, I should stop using them, or else my skin will become very sensitive and fragile.
However, many dermatologists in online videos suggest that during the stable phase of acne, I can continue to use them daily like a moisturizer.
(4) When applying tretinoin and azelaic acid, should I apply moisturizer first and then the ointment, or should the ointment be applied first, or can they be mixed together?
(5) For daytime outings, should I apply azelaic acid first and then sunscreen? Please clarify the order of application to resolve my doubts.

Jimmy, 10~19 year old female. Ask Date: 2022/08/23

Dr. Wu Yuxin reply Dermatology

1.
If it itches, stop using it and discuss it with your doctor.
2.
It can be applied to the entire face.
3.
It can be applied continuously.
4.
Apply lotion first, then apply the ointment.
5.
It is not recommended for daytime use.

Reply Date: 2022/08/23

More Info

When it comes to the use of acid creams, particularly retinoids like adapalene (A酸) and azelaic acid (杜鵑花酸), for acne treatment, there are several important considerations to keep in mind. Here’s a comprehensive response to your questions based on current medical understanding and practices.

1. Itchy Skin Reaction: If you experience significant itching after applying adapalene on your neck, it may be a sign of irritation. It is common for retinoids to cause initial irritation, redness, or peeling, especially when starting treatment. However, if the itching is severe or accompanied by swelling, it is advisable to stop using the product temporarily to allow your skin to recover. You can resume use once the irritation subsides, but consider applying a moisturizer beforehand to mitigate irritation. It’s essential to listen to your skin; if the discomfort persists, consult your dermatologist.

2. Application Areas for A酸 and 杜鵑花酸: Both adapalene and azelaic acid can be used on the entire face, not just on inflamed areas. While some practitioners may recommend spot treatment for active lesions, using these medications across the whole face can help prevent new breakouts and manage overall skin texture. The concern about developing resistance is less applicable to topical retinoids and azelaic acid compared to antibiotics. However, it’s crucial to follow your dermatologist's advice tailored to your specific skin condition.

3. Continued Use After Treatment: After the initial treatment phase, many dermatologists recommend continuing the use of retinoids as part of a maintenance regimen. This can help prevent future breakouts and maintain skin health. However, it’s also true that prolonged use can lead to increased sensitivity. Therefore, it’s essential to find a balance that works for your skin. Some patients may use these products a few times a week rather than daily to reduce sensitivity while still benefiting from their effects.

4. Application Order: When applying topical treatments, the general rule is to apply the thinnest products first. In this case, you should apply the acid cream (A酸 or 杜鵑花酸) first, followed by a moisturizer. This allows the active ingredients to penetrate the skin effectively. Mixing the medications with your moisturizer is not typically recommended, as it may dilute their effectiveness.

5. Daytime Routine: For daytime use, you should apply azelaic acid first, followed by sunscreen. Sunscreen is crucial when using retinoids, as they can increase your skin's sensitivity to UV rays. Ensure that you use a broad-spectrum sunscreen with at least SPF 30 and reapply it throughout the day, especially if you are outdoors.

In summary, while retinoids and azelaic acid can be highly effective for treating acne and preventing future breakouts, it’s essential to monitor your skin’s response and adjust your routine accordingly. If you experience significant irritation, consult your dermatologist for personalized advice. They can help you develop a regimen that balances efficacy with skin comfort, ensuring that you achieve the best results without compromising your skin’s health.

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